肝癌的放射治療

Radiotherapy for Hepatocellular Carcinoma

成佳憲(Jason Chia-Hsien Cheng)

《中華民國癌症醫學會雜誌》 24卷5期 (2008/10) Pp. 318-322

https://doi.org/10.6588/JCOS.2008.24.5.7

摘要

使用於肝癌放射治療的種類包括體外光子放射治療設備，體內近接放射治療，及質子放射治療。大多數的臨床經驗來自於使用直線加速器的光子放射治療。亞洲肝癌病人與歐美肝轉移病人在肝功能背景上的本質不同。即使報告顯示肝癌放射治療的腫瘤有效率在40-70%，但對存活率的影響則尚未有控制良好的臨床隨機分組研究証實。值得注意的是控制腫瘤外的肝內或肝外轉移問題，這些爭議也都因各研究選擇病人間偏差而受到影響。質子放射治療可較光子治療給予更高的腫瘤劑量但更少的正常肝臟劑量，有助於創造更高的腫瘤控制率及存活率。放射性肝毒性，定義為第三級或更高的肝毒性，常被低估及忽略。臨床研究顯示台灣病毒性肝炎帶原者的肝臟放射線忍受力遠較西方國家為低，且肝毒性的背景常是急性B型肝炎發作。現今的資料顯示光子放射治療使用於肝癌病人仍需謹慎的挑選，特別是病人應不合適於使用手術治療，血管栓塞治療，酒精注射治療，以及微波燒灼治療後的情況。

關鍵字

肝癌 ； 放射治療 ； 復發型態 ； 放射性肝毒性

並列摘要

The facilities used include external photon RT, internal RT, and proton therapy. The most experience comes from external photon RT by linear accelerator. The striking difference in biological reserve of liver deserves special attention between the Asian patients with HCC and the American patients with liver metastasis. Although the response rate of the treated hepatic tumor reportedly ranges from 40% to 70%, the survival impact has not been extensively verified in the controlled trial. The reported patterns of failure in few studies, such as improved local control but increased extra-hepatic metastasis, were likely confounded by selection criteria of patients. Proton therapy is capable of delivering higher doses to tumor but smaller doses to liver than conventional photon RT. With the higher doses by proton, non-randomized series demonstrated promising intrahepatic control rate and even survival outcome. The radiation-induced liver disease, defined as grade 3 or greater hepatic toxicity, is frequently underestimated. The dosimetric analysis of HCC patients in Taiwan demonstrated much lower hepatic tolerance to radiation than the tolerance in the western countries. The underlying pathogenesis has been proposed as hepatitis B virus reactivation. The current data by photon RT only support its cautious use in selected patients excluded from the indications of conventional modalities, such as surgery, chemoembolization, ethanol injection, and radiofrequency ablation.

並列關鍵字

hepatocellular carcinoma ； radiotherapy ； pattern of failure ； radiation induced liver disease